Managing EMS Assists: A New Approach?

In my hometown of Columbus, the Fire Division utilizes Engine Companies to "chase" or first-respond for ambulances hundreds of times a day.  It was not always this way here, or in many other cities across the United States which have adopted similar approaches. Some claim this is the best use of their taxpayer dollars and others claim that it "gets the engines involved in EMS." Most can offer no effective rationale for the policy at all.  

This is especially problematic in a City where the response times are extended and the Engines are ALS. Dispatching both resources from the same station to the same call is a risky proposition.  The policy ensures that the response times for the second incident in that neighborhood will either be extended and/or "outsourced" to another department on Mutual Aid. It also wears out the apparatus faster-- as well as the firefighters who are on the rig. 

We must work smarter if we are going to ensure the public safety of our community and the effective use of taxpayer dollars. Here is just one possible idea of an approach that could work here in Columbus.  

Each CFD station is assigned a Pick-Up truck vehicle for random errands and tasks that do not require a fire apparatus-- such as inspections, hydrant duties, etc.  I would propose that Columbus implement an EMS pilot program with the (8) busiest stations which have an Engine and Ladder Company housed together. In these stations, both the engine and ladder would start the day with (4) personnel each instead of (3).  The 4th person from the Engine and the 4th from the Ladder would be assigned to the Station Truck to handle EMS assist runs; CO detectors; Lift Assists, medical alarms, and other minor emergency calls from 8am to 8pm each day. 

For the first three months, this unit would be "on the air" for the entire period-- monitoring the dispatch channel for runs where they can go in-place of a standard fire apparatus.  For the second three months, the unit would be created in CAD and assigned to incidents based on the results of the initial phase. 

At 8pm, this Station Truck would go out of service and the personnel would return to the Engine and Ladder Company to meet the mandated staffing of  (4) Firefighters on each company at night. 

This program would involve some expenses. Outfitting the Station Trucks with additional warning devices, caps or other storage compartments for the EMS gear, and other relevant tools may cost up to $25,000 per vehicle.  However, for the expenditure of $200,000 the City would benefit from: reduced wear and tear on apparatus; decreased response times; decreased effective force arrival time at fires; potentially improved EMS outcomes; potentially improved morale; and a host of other factors. 

With the continued increase in EMS call volumes seen by fire departments across the country and the ever increasing cost of fire apparatus and the related physical and mental strain on fire/ems professionals, the time has come to start thinking creatively about how to deliver EMS in the most effective manner possible.  This was one suggestion.  I encourage you and your community to come up with others. 

I was wrong. 9-1-1 Can and Should Play a role in Improving the relationships between Minority Communities and Law Enforcement

I have been asked several times recently about 9-1-1 and Racial tensions in America. The question has generally been: does 9-1-1 have role to play in addressing this problem?  My first answer was no. After all, 9-1-1 has to take things at face value, right? How can a call-taker decide if someone reporting an incident is exhibiting signs of bias? We are just…. Dispatchers.  

Anyone who knows me well knows the reaction I normally have when someone speaks that phrase.  To realize I fell back on it when discussing with this issue was for me to realize I too have my own biases.  After all, I am the same person who seethes when otherwise respectable acquaintances share memes on Facebook equating kneeling football players with the anti-Christ for daring to bring attention to the relationships between law enforcement community and minorities and the fact that our system of laws and justice too often mean different things to people of color. I have often forced myself to hold back from rage typing   a scathing response about the person’s obvious lack of empathy or understanding. 

Let me be clear here. The statistics surrounding the number of fatal or serious interactions between law enforcement and minorities could be described as painting a picture that the problem is not severe or widespread.  Social media does play a role in exacerbating the events that occur.  But one person’s “isolated event” is another person’s daily life.  There is no “acceptable loss” on this matter—or reasonable number of communities where it is okay for citizens and law enforcement to see each other as the aggressor, the enemy, or a threat before any event or situation even happens. If our nation has even one community where its members feel delegitimized by those sworn to serve them—it is a problem. If there is even one community where law enforcement feels as though it is constantly a target—even when just taking a meal break or sitting in a patrol car—then it is a serious problem. In our you versus me echo chamber of today it is possible for there to me multiple sides to one major problem—but we can never hope to solve that overriding problem if we never see our role in solving it. In some way, that was the very mistake I was making. 

But once we acknowledge that reality that the relationship between African American and Hispanic communities and law enforcement is it should be and that law enforcement should be one of our greatest community assets, then we ca start to make progress.  Race is a factor in too many places for this to ever be dismissed as a trivial concern. Just because it does not impact everyone does not mean it is not real or important. The well documented cases of minorities stopped, frisked, arrested and yes, even killed, raises serious questions about implicit bias, public safety training, mindset, and more.  That some communities seem to have far less problems in this area than others only demonstrates the need for a serious national conversation.  As a nation we need to talk about this—how to solve it—and then how to move forward and beyond into a reality where “driving while black” is not something that can result in a person being stopped, arrested, or worse. And the same applies to the assassination of law enforcement personnel—what kind of nation are we when this occurs even once. Much less in multiple cities across the country. 

This is also one of the best examples of where people who don’t understand why this is an issue need to take some time to learn about why it is an issue. Put yourself in the shoes of those affected.  Think what it might be like, just for one day, to live in a world where this is a real problem—and you are its victim. 

I return to the subject of 9-1-1 and the issue of implicit bias and my own lack of vision. 9-1-1 professionals make decisions about what are real emergencies and not every single day.  Not every car accident requires an EMS response—not every call for a ringing alarm gets a fire engine—and not every call for a person with a warrant results in the person being arrested and transported to the agency where they are wanted. These and so many more examples reflect the complex world which 9-1-1 dispatchers work in.  It is common place to ask additional questions—to try and find out what is really going on—and to provide the best possible information to the responders to ensure they know what they are going into.  

It is time for the 9-1-1 profession, law enforcement, and community groups to come together to identify how we may reduce the dangers associated with calls to 9-1-1 that are not really emergencies but rather cases of people being “suspicious” of someone merely for their skin color.  This is not far removed from what we already do thousands of times a day in 9-1-1 centers all across the country.  We get a little more information to help ensure a safe and effective response.  Public Education is also an important piece.  We already work to eliminate needless calls to 9-1-1 about many types of nuisance items and non-emergency issues, why shouldn’t we also educate our communities about the danger of using 9-1-1 as even a subconscious tool for bias—and the catastrophic consequences that can result. 

Just like many other challenges we face today, there is no single solution for improving relationships between the law enforcement community and minorities. But as one part of what should be a much bigger, more complex effort, 9-1-1 should be at the table, sharing in the discussion, and realizing the role of 9-1-1 professionals in being a part of the solution.